NBA star Tyrese Haliburton was recently diagnosed with shingles. The news drew attention to an illness that many people rarely talk about but is far more common than many realize.
In Canada, 130,000 people develop shingles each year. The infection can cause a painful rash and, for some, long-lasting pain that can affect their quality of life for months.
Yet shingles cases are also largely preventable through vaccination. Despite the availability of a highly effective vaccine, fewer than four in 10 Canadian adults aged 50 and older report having received the shingles vaccine.
As researchers focused on aging and vaccination at Toronto Metropolitan University’s National Institute on Ageing, we study vaccine-preventable diseases, vaccination policies and opportunities to improve prevention in Canada.
What is shingles?
Shingles, also known as herpes zoster, is an infection that typically appears as a painful rash with blisters. The virus responsible for shingles is the same virus that causes chickenpox.
After a chickenpox infection, the virus remains in the body and can reactivate when the immune system weakens due to aging, health conditions or certain treatments. People who received the chickenpox vaccine can also develop shingles, but the risk is much lower.
Illustration of reactivation of shingles virus
The chickenpox virus can remain dormant in the body and later reactivate as shingles. (National Institute on Ageing), Author provided (no reuse)
Symptoms often begin with itching, tingling or pain, followed by a rash that usually appears as a strip on one side of the body, most commonly on the torso. In some cases, the rash can appear on the face.
While the rash typically clears within a few weeks, shingles can lead to serious complications. The most common is post-herpetic neuralgia, pain that lasts more than 90 days and can affect daily activities.
If shingles affects the eye and surrounding area, it can cause scarring and vision loss.
Antiviral medications can reduce symptoms, but they are most effective when started within 72 hours of the rash appearing.
Who is most at risk?
As shingles often occurs when the immune system weakens, the risk increases with age and certain medical conditions.
More than two-thirds of shingles cases occur in adults older than 50, and incidence rises with advancing age.
People who are immuno-compromised, meaning their immune systems are weakened by disease or treatment, are at higher risk. This includes those with conditions such as autoimmune diseases, cancer, human immunodeficiency virus (HIV) and those who have undergone transplants.
Bar graph showing shingles incidence
Shingles incidence is higher among adults with immunocompromising conditions. (Data from Buchan et al. 2020) (National Institute on Ageing), Author provided (no reuse)
Chronic conditions like asthma, diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD) have also been associated with higher shingles incidence.
For many people with these conditions, shingles infections may be more severe, with a greater risk of complications.
The shingles vaccine
There is currently one shingles vaccine available in Canada: Shingrix (generic name non-live zoster vaccine recombinant, adjuvanted), which is given in two doses.
Clinical trials have consistently shown this vaccine provides strong protection against shingles and its complications across multiple populations, with 97 per cent effectiveness against shingles among immuno-competent adults aged 50 and older over three years. The vaccine has also been found to be generally well tolerated among immuno-competent adults aged 50 and older and immuno-compromised adults aged 18 and older.
Recent research shows the vaccine remains highly effective even in the 11th year after vaccination, with 82 per cent effectiveness against shingles among immuno-competent adults aged 50 and older.
Canada’s National Advisory Committee on Immunization (NACI) strongly recommends Shingrix for adults aged 50 and older, including those who previously received the earlier shingles vaccine (Zostavax, generic name zoster vaccine live) or who have had shingles. NACI also strongly recommends Shingrix for immuno-compromised adults aged 18 and older.
The second dose of Shingrix is recommended two to six months after the first dose. For immuno-compromised adults, however, the second dose can be administered at least four weeks after the first dose.
Vaccine coverage remains low in Canada
Despite strong recommendations and a highly effective vaccine, shingles vaccination rates remain relatively low in Canada.
As of 2023, only 38 per cent of adults aged 50 and older reported having received at least one dose of the shingles vaccine. In some provinces and territories, vaccination rates are even lower, falling to around 25 per cent.
Bar graph showing shingles vaccine uptake
Shingles vaccination uptake varies across Canadian provinces and territories. (Data from Public Health Agency of Canada 2024) (National Institute on Ageing), Author provided (no reuse)
One reason is that public coverage for the shingles vaccine varies widely across Canada. Currently, eight of Canada’s 13 provinces and territories provide some level of public coverage for Shingrix, often limited to specific age groups or high-risk populations.
Only Prince Edward Island and Newfoundland and Labrador provide coverage for all adults aged 50 and older. Newfoundland and Labrador also covers immuno-compromised adults aged 18 and older.
Infographic on public coverage of shingles vaccine availability across Canada
Eligibility for publicly funded shingles vaccination differs across provinces and territories. (National Institute on Ageing), Author provided (no reuse)
For those without public coverage, the two-dose vaccine costs roughly $300 to $400, which must be paid out of pocket or through private insurance.
Perception of risk may also play a role in low vaccination rates. One national survey found that 72 per cent of adults aged 50 and older in Canada either do not know or underestimate their risk of developing shingles.
In surveys of older Canadians, the most commonly reported reason for not receiving the shingles vaccine was the belief that vaccination was unnecessary.
Other factors related to vaccine delivery may also influence uptake, including barriers to pharmacist provision and a lack of recommendations from health-care providers.
Preventing this painful infection
Shingles is a common and often painful infection, but it is also largely preventable through vaccination.
Approaches to prevention include increasing awareness, improving vaccine access, encouraging health-care provider recommendations and urging those at higher risk to speak with a health-care provider about shingles vaccination.
These measures can help increase vaccination rates across Canada and prevent a disease that can unnecessarily have a negative impact on people’s overall quality of life.